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Free Content The cost of medical care and people's health-seeking behaviour before being suspected of tuberculosis in three local health systems, Nicaragua

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OBJECTIVE: To assess the medical costs incurred by users and delay between first contact with a care provider and sputum test for acid-fast bacilli (AFB) in three areas of Nicaragua.

METHODS: Directed interviews of consecutive series of tuberculosis (TB) suspects whose sputum had been examined for AFB.

RESULTS: Of 252 TB suspects interviewed, 52% used more than one type of care giver and 35% used private practitioners. As a consequence, 18%, 21% and 29% of the interviewees in Carazo, El Viejo and Matagalpa, respectively, spent more than 1 month of the country's median income per inhabitant on medical care between the first visit to a care provider and the first sputum examination. Furthermore, more than 3 months elapsed on that part of the care pathway for 30%, 17% and 3% of interviewees in Matagalpa, El Viejo and Carazo, respectively.

CONCLUSION: This study sheds light on the costs and delays incurred by TB suspects before reaching a laboratory for sputum smear examination. Both costs are lower for those suspects who exclusively use first-line governmental health services (FLGHS). This has been relatively little documented in Latin America to date and could be used as an argument to develop strategies to strengthen the credibility of FLGHS.
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Keywords: Central America; access to TB diagnosis; cost to the patient; health-seeking behaviour

Document Type: Regular Paper

Affiliations: 1: Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium 2: Centro de Investigaciones y Estudios de la Salud, Universidad Autonoma de Nicaragua, Managua, Nicaragua

Publication date: 2004-11-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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